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Harm Reduction And Evidence-Based Drug Policy

A few months ago a rather important decision was made in the Canadian supreme court. InSite, Vancouver’s safe injection site (North America’s only safe injection site, as it happens) was permitted to continue operating.

InSite was a highly controversial project when it was first proposed. It operates as a place where IV drug users can go to self-administer their drugs in a sterile, safe environment. Trained nurses, and emergency medical supplies such as oxygen tanks, narcane and heart and blood-oxygen monitors are on hand in the event of an overdose. Sterile, fresh syringes, as well as other supplies such as sterile water ampules, sterile cookers, tourniquets, bandages, cotton and dry/sterile filters, and alcohol swabs are all available. The facility is equipped with a “chill lounge” where users can stay for a short while while high to make sure they’re safe. Coffee and juice are served, and sometimes sandwiches and pastries are provided by other charities. Condoms and other safe sex supplies are made abundantly available, bulletin boards post important messages such as warnings about especially dangerous drugs going around, the absolutely invaluable “red light alert” which shares information from sex workers about dangerous or hostile or unpaying tricks, information about shelters and free services and programs, as well as missing persons alerts. Social workers and community outreach specialists are on staff to help allow addicts to be able to access social services, health services and rehabilitative programs through the site. Finally, the upstairs portion of the building operates as OnSite, a drop-in detox center where addicts can be temporarily housed for free in a drug-free environment while they detox or simply try to move to less dangerous dependencies such as methadone. OnSite has a staff doctor and nurses.

It is without a doubt one of the most intelligent and well-designed programs in the history of harm reduction approaches to drug use.

What is interesting though is how despite the fact that InSite is entirely based upon well-documented and thoroughly researched evidence and medical knowledge, it was enormously difficult to have the project approved and up until just a few months ago its future and continued existence were very much in doubt. I’m troubled by the degree to which the skeptical community seems to have failed to acknowledge how much evidence and scientific consensus is swept aside when dealing with drug policy. Here we have a glaring disregard for evidence and reality occurring on an institutional and legislative level, with broad and severe consequences for an enormous number of human beings, but our community is curiously silent on the issue. Why?

InSite was initially proposed as a scientific “pilot project”. Its intended purpose, or at least the purpose that was required to exist on paper so as to gain the necessary parliamentary approval (and constitutional exemptions needed for it to legally operate), was as a means of testing whether or not a project such as this would indeed reduce the negative consequences of an urban drug epidemic. What’s interesting, though, is that everyone was already well aware of the fact that it would. We already had the evidence, as well as a consensus across numerous disciplines -sociologists, epidemiologists, physicians, analysts of law enforcement, etc.- that harm reduction models like needle exchanges, methadone clinics and safe injection sites work wonders and are vastly superior to models that prioritize enforcement and deterrence. However, as with other concepts around which a scientific or academic consensus exists that is politically unacceptable or inconvenient, it was painted as only a theory… “the jury still out”.

The actual results of the “pilot project” testing the efficacy of “theoretically beneficial” harm reduction strategies emerging from InSite have overwhelmingly confirmed the original hypothesis. Overdoses within the Downtown Eastside were dramatically reduced by 35%. Since opening in 2004, serving about 700 individual addicts per day, InSite has not had a single on-site fatality (despite 1418 overdoses in the first six years of the project). HIV/AIDS rates have dropped, the alleyways in the neighbourhood are no longer littered with used rigs and the dreaded “honeypot effect” (in which addicts would supposedly flock to the area) that was used as a principal argument against the opening of the site never came to pass. In every conceivable way, InSite was an immediate and overwhelming success.

So why then did it even need to go to the supreme court in order to continue its operation? Why is it still the only such facility in North America? Why are harm reduction strategies still scoffed at, and receive comparatively so little funding? Why is the data and evidence that has emerged from InSite (and similar projects in Germany, Switzerland, Australia and The Netherlands) disregarded when legislative bodies determine drug policy? Why do American politicians still enjoy claiming that Vancouver is engaging in “state sponsored suicide” and leaning heavily on our government to shut it down? (seriously, fuck those guys. It’s a Canadian city, a Canadian problem concerning Canadian citizens, a Canadian solution, and none of their fucking business).

Vancouver politicians currently like to talk about a “four pillars” approach to the city’s drug problem. The pillars are: harm reduction, prevention, treatment and enforcement. In terms of actual funding, though? The running joke in the DTES is that it’s actually one pillar and three toothpicks. VASTLY more money gets poured into the enforcement of drug policy than into the various programs designed for harm reduction, preventing people from becoming addicts, and providing addicts access to treatment. Despite the fact that enforcement/deterrence has been consistently proven the least effective of those models.

Occasionally you’ll see some kind of politician or law enforcement dude or academic or so-and-so (like the absolutely awful -and occasionally casually transphobic- professor Bruce Alexander) start claiming that the harm reduction methods haven’t successfully eliminated the epidemic of addiction in our city. The harm reduction models aren’t intended to eliminate it. They’re intended to mitigate the actual social consequences. The prevention and treatment programs are the ones designed to lessen the problem as a whole. Meanwhile, NONE of those models have been given the time and funding they need to properly see through their missions. The idea that we should cancel them and go back to the thoroughly ineffective strategy we had previously been following, just because other strategies haven’t achieved an unbridled miraculous success from the tiny little scrap of a chance they’ve yet been provided is absolutely absurd. And the funny thing is from that tiny scrap of a chance the harm reduction programs like InSite HAVE achieved monumental success, despite the ridiculous amount of opposition attempting to hinder and undermine their ability to do their job. The degree to which people are simply assuming that the enforcement/deterrence model MUST be the one we ought to pursue, ignoring all evidence and reason, is simply ridiculous.

It is more than clear at this point that we have somehow gotten to the point where drug policy in most nations, and perhaps especially The United States, is being dictated by irrational fear, prejudice, hatred, old habits, money, bitterness, and an utter lack of compassion or tolerance for addicts themselves. This is an area of legislation where reason, science and evidence has somehow been completely tossed out the window and our governments are stumbling blindly forward driven only by the hostility and emotions of its members and constituents.

The consequences of this, of allowing our drug policy to be dictated by everything but actual fact and actual thought, are staggering. The number of lives being needlessly lost or destroyed, the amount of crime and poverty being perpetuated, the implicit genocide of minorities still suffering from legacies of oppression, it all adds up to one of the darkest and most inhumane atrocities in recent human history. So long as we continue to ignore the evidence stating that this is NOT a necessary atrocity, that there ARE strategies that can help spare these lives, so long as we don’t push for it to be acknowledged that a better and more compassionate approach is available, we are complicit in this.

As skeptics we’ve committed ourselves to standing against reasonless, unfounded, and dangerous irrational beliefs, haven’t we? Shouldn’t we be most invested when those irrational beliefs start exacting a human cost?

How high does that cost have to become before we recognize this issue as one we should be addressing?

Comments

  1. Anders says

    How high does that cost have to become before we recognize this issue as one we should be addressing?

    The cost have to affect us, I’m afraid. I was rocked to the core of my being when I read that you are a recovering heroin addict. That such an intelligent, well-spoken, well-educated young woman… yeah, I’m showing my prejudices, aren’t I? That was actually more of a shock than the 41% rate of suicidal ideation and suicide among trans people. I’m having to relearn a lot of what I’ve learned on this site. Which is good.

    Anyway, as long as we skeptics belong to a privileged group who don’t have to face this, we’ll continue to be uninterested. Our children are not dying of overdoses and HIV in DTES (Downtown East Side?*), we don’t live there and have to walk through the heaps of disposed rig (would that be needles?) and it’s not our flats that get robbed by people desperate for money for another fix. And what we don’t see doesn’t exist. Skeptics are no more immune to this than anyone else.

    So we need someone to tell us. We need to be able to put a name to the statistics and the findings and shove the data down our throats if need be. Just as we need to with trans people and their problems. The crux of the matter seems to be that there’s only one Natalie. But what you do is important, never never never forget that. And thank you for showing me my prejudices. It will take some time before I’ve internalized this, but I will.

    *When I was writing articles (well, article) I learned that if you use an abbreviation you introduce it after the first time you use the full name. Like so: Downtown East Side (DTES).

    • Anders says

      I’m having to relearn a lot of what I’ve learned on this site.

      That came out wrong. This is what I mean: “This site is forcing me to relearn a lot of what I learned.”

      Maybe I should use that preview button…

    • Anders says

      Meanwhile, the war on drugs is costing lives in Afghanistan. According to the Swedish foreign secretary:

      In 2011 the ratio between gross income from opium and wheat in Afghanistan was 11:1 – the most unfavourable ratio for wheat since 2003.

      So… we are forcing them to produce something which gives them a tenth of what they could get? Yeah, that’s a humanitarian policy right there. Granted, if opiates* were legalized they wouldn’t get ten times as much but twice or three times as much is a distinct possibility. I think they could use that money.

      *opoids are substances that binds to and activates the opioid-receptor. Opiates are substances chemically related to morphin. Methadon is an opioid but not an opiate. Naloxon is an opiate but not an opioid.

    • Tualha says

      Speak for yourself, Anders. My brother’s meth addiction hasn’t killed him yet, but he’s lost everything he owned, has a felony conviction on his record, and is living on the streets. He’ll have one hell of a time getting his life back together in the unlikely event that he ever manages to stop using.

      Really, am I the only one here who has a family member with a drug problem? Several co-workers have told me about siblings or cousins or other not-too-distant relatives with active addictions. I don’t think it’s all that rare.

        • Happiestsadist says

          Good point. I’ve got more than a few people with addictions in my own family, but the fact remains that addictions and their outcomes/related problems don’t happen in a void.

      • Anders says

        But perhaps even more damaging is the idea that drug use is something which only happens to the lower classes and the jet set. It is true that there is an overrepresentation, but as you say, it is by no means absolute.

        The reason this idea is so damaging is that it allows us to look at the people from the middle class who actually do fall prey to substance abuse and say “They are exceptions to the rule”, or even “They were never truly middle class in the first place.” So you are probably right that it’s more common than I gave it credit for.

        Must think about this some more.

        • Dalillama says

          Yeah, I’ve been beating this drum for ages, since all the way back to the days when I was a hard core right-libertarian. I am a fervent believer in empiricism, in politics as much as everywhere else, and it’s blisteringly obvious to anyone with a brain what works and what doesn’t.

        • jeffengel says

          I think this gets at why viciously irrational policy gets so much of a pass when it’s drug policy: the perception, and the relative fact, that it’s a problem for the very well-off or celebrated and (much more) for the impoverished. The educated, politically active and confident class tends to come from in between, where envy can dismiss misfortunes the jet-set have and fear of falling down the economic ladder makes it too tempting to think poor people get what’s coming to them.

          This is another instance in which Natalie’s “don’t be too sure, question everything” variety of skepticism will have a different interest than will the “go science!” variety. “Go science!” doesn’t have a dog in this race – it doesn’t seem to come out of religion, other superstitions, urban legend or what not. “Question everything” skepticism has us take a good, hard, insistent look at our own blind spots, after we notice them at least.

          • Dalillama says

            I disagree. Science absolutely has a dog in this fight. Science is what we use to distinguish between effective treatment and ineffective treatment, science helps us learn what factors go into addiction and how we can reduce the number of people who become addicted to drugs in the first place, etc. That’s the point of looking at social policies with a scientific framework, you can learn what actually produces desired outcomes. In this case, desired outcomes include fewer people addicted, fewer deaths and health issues associated with addiction, higher recovery rates from addiction, etc. Science is how we learn what actions do and don’t produce those outcomes.

          • jeffengel says

            I agree with everything but the first word. :)

            I was taking drug policy as a skeptical issue, without making any claim about it as a scientific one – you’re right on on that score. I had in mind the two strains in the skeptical movement Natalie identified in http://freethoughtblogs.com/nataliereed/2012/02/08/the-duality-of-skepticism/ – to which I really ought to have linked in the first place.

            I’m just claiming that this is one of the issues that is more likely to grab the interest of the skeptics more likely to challenge social and political biases than those asserting confidently the power of naturalism and the (hard) sciences, although there are ways to represent it that may broaden the skeptical interest.

          • Dalillama says

            Oh, yeah, I know. I suppose that I that’s an expression of how utterly misguided I find skeptics of the first type (per Natalie’s identification, which I broadly agree with). They seem to insist that there are whole categories of things that are simply not subject to testing in a methodical and empiricist, which is to say scientific, manner.

    • Merk says

      I think one extra wrinkle to it is that when people with no other perspective on these harsh realities do see them, it’s often through the lens of crime. Perhaps not experiencing it themselves, but at least through the media drug use and crime are tightly intertwined, and I think that makes people fearful. Then the response becomes punish the drug user, because they’re always the aggressor in the fearful mind, they’re dangerous and must be locked away. The desperate acts of desperate people are seen instead as the depraved acts of callous and indifferent people, there’s no room for charity there.

  2. Chrisj says

    The problem, in my experience, is that to the supporters of the enforcement model it isn’t (despite the claims some will make) actually about what “works”, it’s about punishing people for being different. But if anyone comes up with a good way of making authoritarians see sense, I’m all ears. I’ve had/seen too many discussions where “but if we don’t send them all to prison, how will everyone else know it’s wrong?” is regarded by one side as the unanswerable crowning argument.

    • Janstince says

      My response to that kind of “argument” has been twofold:

      1) So, how’s that working out for you? We still see addiction rates and imprisonments rising with no end in sight. And you want more of the same?

      2) Other places, other countries have adopted the harm-mitigation model, and they have seen no change or actual declines in addiction, as well as more recoveries, and fewer state-paid medical bills, fewer drug-related crimes, lower rates of blood-related illness transmission, and less medical waste laying around where a kid could get to it.

      Part 2) usually gets the “yeah, but wait until tomorrow” attitude thrown at it. As if these clinics had just popped up overnight and were going to be swarmed the next day with violent hookers giving bumps off their butts and teens experimenting with melanges for the first time. Part 1) seems to get no real opposition, just ignored.

  3. michaeld says

    I was very happy when the supreme court ruling came out. Its incredibly frustrating to see our and other governments dumping gobs of money into ineffectual projects and policies as they slowly sink in debt. I would love to see a party based on empirical evidence and removing our national debt…. alas its but a pipe dream.

    “Occasionally you’ll see some kind of politician or law enforcement dude or academic or so-and-so (like the absolutely awful -and occasionally casually transphobic- professor Bruce Alexander) start claiming that the harm reduction methods haven’t successfully eliminated the epidemic of addiction in our city.”

    In regard to that sleazy bit of reasoning I don’t think your enforcement policies have wiped out the problem either. Maybe people in glass houses shouldn’t throw stones.

  4. rork says

    “and none of their fucking business”
    Lack of standing is most often used by Americans, to say we should pay no attention to solutions working in other countries, or the opinions of folks not in the city, state, or country.
    The other person may be hopelessly wrong, but this is never an argument that they are wrong.
    Avoid this argument. You don’t need it.

    • says

      That was actually the part of the entire post which made me cheeriest. The US is *constantly* meddling with its allies (the UK, Germany, Australia and France are all the US’ “closest ally” according to Obama in the last two years) and people resent it. I resent it. I’m sure Iraq and Iran both resent it. If the US was markedly /better/ than anyone else then they might have a leg to stand upon, but they sure as hell are not.

  5. Stevarious says

    It is more than clear at this point that we have somehow gotten to the point where drug policy in most nations, and perhaps especially The United States, is being dictated by irrational fear, money, prejudice, money, hatred, money, old habits, money, bitterness, money, and an utter lack of compassion or tolerance for addicts themselves. And money.

    FTFY.

    The policies are dictated by money. The policies are supported by all those other things.

    • Tualha says

      I think Natalie left out power. In the US, the War on Drugs ™ has been a marvelous tool for letting politicians poke holes in the Constitution and get away with it, and for letting police commit all sorts of abuses and get away with it (not that the latter really need it to do that).

      • Tualha says

        D’oh. I forgot all about its scope for disenfranchisement. So sad for racists in southern states, Jim Crow’s illegal now, no poll taxes or literacy tests, black people have the vote. No problem, they say – just make sure to get lots and lots of felony convictions, for anything at all, on the people you don’t want voting, and pass laws prohibiting ex-cons from ever voting again. And they did.

  6. Erin W says

    I’ve never been a drug user, but my home city (Philadelphia) has such a large overlap between the drug user, sex worker and trans* communities that it’s something I came to learn about very quickly. It certainly helped humanise the issue for me to find out that the first people that helped me go full-time were all people in various stages of addiction and recovery. There’s a group that tries mightily to implement harm reduction strategies, and the LGBT health clinic has an underground needle exchange program that operates with a wink and nod from the city, but their attempt to open a mobile program with a van and all was shut down by the state very quickly.

    I don’t need any convincing on skepticism and social policy, but I too wish I knew a better way. I think I have to agree with Anders. The same way people begin to change their mind about trans* and LGB people when they actually know them is probably the same thing it will take to get people to treat drug issues as something other than ‘hippies and crackwhores who deserve what they get’. Getting the Calvinist morality out of the US culture would help a hell of a lot, too.

    • Anders says

      Protestantism in general… Sweden has a very hard-line policy on drugs and we’re Lutherans. It has more to do with what I’d call “the patron’s attitude” – I’ll take care of you and protect you and in return you’ll let me run your life. In this case, ‘running your life’ means deciding that you can’t put a needle in your arm and if you do the patron has to spank you. And the patron isn’t necessarily the state, but in this case it happens to be.

      Here’s another example, on-topic for the blog if not for this specific post: http://www.parentdish.co.uk/2012/02/13/boys-should-be-able-to-wear-skirts-to-school-says-childrens-adviser/

      “Gender is determined by objective biological facts and not by a person’s feelings, no matter how strong they may be. Rather than encouraging children to become what they are not, we need to help them recognise and accept what they are.

      Incidentally, I completely agree with the second sentence… ;)

      “To that end, maintaining a distinction between what boys and girls are required to wear can be positive and helpful for pupils struggling with gender identity issues.

      Yes. Let’s force the trans women to wear trousers. It will help them recognize that they are really manly men and need to embrace their boy-dom.

      *headdesk*

  7. Ace of Sevens says

    If you can figure out a way for deep pockets investors to make a bunch of money off this (maybe Pfizer can sell clean crack to the government at inflated prices), then we’ll see it elsewhere.

    • Megan says

      Naah, Pfizer would never go for selling crack – it’s been around long enough that they wouldn’t be able to take out a lucrative patent for it. But if they had a new-fangled, addictive, dangerous designer stimulant that the government would allow them to patent for sale? They’d be on that so fast that your head would spin.

    • Anders says

      I read somewhere that a reason rock stars don’t die in their 20s anymore (most of the time) is that we’ve become better at treating heroin overdoses. That has probably saved a few non-rock star lives as well…

      Is that what you’re talking about?

      • says

        No, it was an accidental cocaine overdose actually. I had to buy from someone I didn’t trust, he sold me the wrong thing, I didn’t check it beforehand (even though my instincts were saying “this looks a little off”) and…yeah. I hardly ever do cocaine, like less than ten times in my life. I’d NEVER injected it. I had no tolerance at all. And what’s a manageable dose of heroin is not necessarily a manageable dose of blow. And there I was shooting a TON of coke directly into my vein. Immediately my mouth and extremities all went cold and numb, this incredibly strong tinnitus ringing appeared in my ears, I felt my heartrate leap up and every breath I took felt freezing cold and like it was blowing right through me. I knew right away what was happening and bolted to the nurse, tried to tell her, and then they calmed me down , put a cold compress on my neck to slow my blood, checked my stats (my heartrate was TWO HUNDRED BPM… that’s like a professional athlete at absolute peak performance) and made sure I didn’t stroke or seize. If I’d been by myself in an unsafe environment the fear and panic alone probably would’ve caused me to go into cardiac arrest.

        • Anders says

          That’s… you’ve had an interesting life. I’m fairly sure I don’t envy you.

          You see, when I hear stuff like this happen to one of my friends (shut up – you are officially one of my friends) I just want to hold them for a while until things feel better. You must have been so miserable…

          • says

            Well… I don’t really regret anything. I did what I needed to do to survive. I was self-medicating, and in a sense, it worked, it managed the symptoms. Eventually I was able to address the underlying illness and get better.

            It hasn’t been an easy life, yeah. But there’s a great deal I’m grateful for, and I’ve also had some amazing experiences and met some wonderful people and seen some beautiful things. And where I am now is a pretty decent and happy place, and getting better all the time. My future doesn’t look half bad right now. Without my struggles and my history, I wouldn’t be where I am.

            And really, we ALL have our suffering and struggles to face. Mine just took on a sort of more…um.. direct quality, I guess? In a way, it almost made things easier, that my demons had a name and a form and a solution.

          • Anders says

            Much of my unease probably comes from me not knowing your world. We have a very efficient and powerful propaganda apparatus telling you that if you smoke one joint it’s dying of a heroin overdose on a filthy toilet within a week.

            With little information to go on I’m left with my imagination, and I have a fairly vivid such.

            Anyway, you came to grips with your demons and in your skepchick post about your less-than-successful life as a gay man you said that was a post for another time. When? We wants it!

            Disregard if you feel you’re not up to telling it yet. It sounds like a story worth waiting for.

          • says

            Well…actually, the first Coming Out post I did at Queereka was originally meant as part of a series. A series that, as it happens, I’ll be completing over the course of next week. Part One is that post, about coming out as “gay”. Part Two is about disclosure, “spooking”, stealth, and the fundamental differences between what “out” means for LGB people vs. what it means for trans people. Part Three is about when I actually came out trans and told my friends and family that I was transitioning. And Part Four is about the implications of coming out, why it matters, and why it matters to atheists and other minority groups.

            But yeah… I can’t really tell my entire life story in just a few blog posts. Also, I want this blog to be about a lot more than just ME, you know? I use my life as a touchstone for exploring certain concepts, illustrating the actual ways certain things play out in real life and effect people, and demonstrating the human element behind some things. But my ultimate goals are on discussing the actual topics I’m discussing.

            Gradually over time I’ll tell more and more stories about myself, but that’s just not really my priority, you know? Also there’s some things I just don’t really want to talk about or explore. Some stuff is off-limits entirely. Like I will never ever reveal my boyname, nor will I ever discuss the details of the time I was raped. And then a whole bunch of my life I’m probably not ever going to talk about just because lots of it are actually rather boring and mundane and don’t really help illuminate any important ideas. Y’all don’t need to know about the day I decided I like Siouxsie more than Peter Murphy, or who my favourite X-Man was, or the time I managed to nearly break my ankle on Christmas Eve making snow angels.

          • Anders says

            Good points all. I await further posts with interest. The reason I want to know more about you is that… well, first of all you are an interesting person. Second, it helps me understand the perspective you have on the issues and how they differ from mine.

            So you’ve been raped as well… *sigh* *hugs* Yeah, I have a friend who was raped when she was 11. She’s still suffering the effects 20 years later. *shakes head* Bad stuff.

            May I, in a typical overdramatic fashion, suggest a motto for the series:

            Long is the way and hard, that out of hell leads up to light.

            Slightly in jest but mostly serious. Sleep tight.

        • Anders says

          As part of my anxiety management regime I looked stuff up. Typical dose for cocaine is 50-75 mg (injection of as little as 20 mg can be lethal). Heroin 5-15 mg, or 20-60 mg with heavy tolerance. But injected cocaine would be much more dangerous than other routes because you get it all at once. Pharmacokinetics, where would we be without you?

          I also read up on the dangers of heroin abuse… skies above woman, what have you been through?

          • Anders says

            And also, how many others like you have we lost through sheer pigheaded stubbornness from those who make the decisions?

          • says

            I also read up on the dangers of heroin abuse… skies above woman, what have you been through?

            Oh, you know… pronounced gender dysphoria, sexual assault, severe depression, suicidal ideation, ongoing poverty, endorphin deficiency, internalized transphobia and internalized sexism and internalized trans-misogyny… nothing special. ;)

          • Anders says

            BTW, this gender dysphoria is something I don’t get. Sometimes when I hear about it it seems to be a constant, low-grade unease nagging at you. Almost like Generalized Anxiety Disorder… but then sometimes it’s described as something acute, more like a Panic Attack. What have I gotten wrong?

          • says

            Well it can work either way. It’s basically a deep-seated sense of unease, discomfort, dissatisfaction and sometimes disgust. Sometimes it can become really, really intense under certain circumstances (such as while naked, for instance) and sort of fade away under other circumstances. Sometimes it becomes a more anxiety or dread oriented thing (especially when one starts having to acknowledge the inevitability of transition, or just the fact that your feelings aren’t going to go away, or even just naming it for what it really is). But in my experience is was typically more of a depression thing.

            With me, it’s sort of odd, in that I sort of mistook myself for suffering from severe depression. I knew that the GID was contributing, but I figured that it was only one part of it, and that I’d still have depression anyway. But transitioning almost completely eliminated my depression. Like I went from being quite literally suicidally depressed to being a generally pretty chipper, happy, easy-going kind of girl JUST from taking hormones for a few months. So THAT’S how much of a profound emotional effect gender dysphoria can have.

            The thing, though, is that it’s typically subtle and sort of in the background. You’ve lived with it more or less your whole life, so you don’t know what it’s like to NOT be experiencing it, so you don’t really know what is the dysphoria and what’s just you. And then it overlaps with other things, and we rationalize it and deny it, and there’s all kinds of psychological stuff going on and associated things like self-hatred, internalized transphobia, etc…. it’s complicated.

            But it definitely can vary in intensity, and there can definitely be certain “triggers” that can cause it to emerge in a more acute manner. I still get those, actually, even though the “background” dysphoria is mostly gone. But certain circumstances (like being clocked, or someone laughing at me or shouting a slur from a passing car, or even simpler things like someone remarking on my height) will bring it back and remind me that there are still things about my body and my sex that I wished weren’t true but I can’t do anything about.

          • Anders says

            Yeah, technically speaking you probably shouldn’t have gotten the diagnosis depression because your symptoms were better explained by GID. It’s part of the weaknesses of DSM – you can’t really have two diagnoses at the same time.

            Interesting… I remember when we talked about restrooms Anna (I think?) said that having to choose between restrooms could trigger gender dysphoria.

            *shudders* I’m glad I don’t have it.

          • Anders says

            So… excuse me for harping on this but I feel it’s a key point for me to understand. A friend posted this on another forum:

            After having about two and a haf months of being relatively content being a male – which annoyingly happened just as I’d finally resolved to start working on this androgyny business – I woke up this morning hating my body hair, lack of curves, and general maleness. It drove me to shave my arms this morning, and I’m currently doing something I’ve never done before – I’m wearing an (admittedly unstuffed) bra on campus.

            This would be gender dysphoria? Although he (that’s the preferred pronoun) calls it dysmorphia.

          • Megan says

            Re: what your friend posted, that sounds like dysphoria to me. It sounds very much like how I felt when I first came out as trans and hadn’t done anything to change my body yet. Not that I can diagnose your friend as being trans, of course, but it does sound awfully familiar to me.

            As for the term dysmorphia, I’ve only seen it used a few times in regard to trans stuff, but from what I understand, it’s pretty much used as a synonym for the body-oriented parts of gender dysphoria. It’s probably a good idea to ask your friend what he means by it, though.

        • dysomniak says

          What’s really fucked up is that (ahem) some people shoot doses like that on purpose. Like dozens of times in a row. Fortunately (I guess) it’s not a very sustainable habit.

  8. says

    And also, how many others like you have we lost through sheer pigheaded stubbornness from those who make the decisions?

    This is probably what upsets me most about the War on Drugs. Just like any other war, there are huge costs in both life and money.

    There really should be more centers like InSite. But no, it’s just easier to blame addicts and say they deserved it.

    • Rasmus says

      Yeah and the weird part is that I think that almost all people have that one (at least one) family member or relative who’s an addict or ex-addict. Most probably think that it would be good if the government provided basic services for their relative. I can’t even imagine anyone would object to an NGO doing it.

      Of course, my relative is one of the nice addicts…

      • Anders says

        I don’t know about that. Playing off of peoples’ fears can be a quick way to power. Rhetoric about rewarding drug use, tales of junkies getting high in children’s playgrouds or raping little girls… and where do you place the clinic? People would be afraid of the ‘honeypot’ effect (interesting new term) and complain endlessly. There are no votes in helping drug abusers. But there are many votes to lose.

        The Swedish party Folkpartiet focused one of its campaigns on “the Forgotten Sweden”, the parts of the country no one talked about. I think it was a good idea even if the execution wasn’t perfect.

        • Rasmus says

          Well, the homeless junkies already gather in certain places and the ones that have a home typically aren’t a problem to the public anyway.

          That said I would guess that it would be better to focus on providing cheap housing and regular home-visits. There is absolutely no rational reason why there should be homeless people in country with a GDP of ~$50,000 per capita. There are a ton of empty buildings for one thing. Sometimes right in the middle of major cities. But those buildings are certified for commercial use. Plus the neighbors might make a fuss. So we let them sit empty for years before they are demolished.

  9. says

    It is more than clear at this point that we have somehow gotten to the point where drug policy in most nations, and perhaps especially The United States, is being dictated by irrational fear, prejudice, hatred, old habits, money, bitterness, and an utter lack of compassion or tolerance for addicts themselves. This is an area of legislation where reason, science and evidence has somehow been completely tossed out the window and our governments are stumbling blindly forward driven only by the hostility and emotions of its members and constituents.

    Ultimately politicians will enact decisions that support their power base. In a democratic country that means winning votes. So the prejudices, fears and hatreds of the median voter are enshrined in policy. Most people think poorly of addicts, so assitance to addicts is looked at askance by voters. So you get a lot of punitive measures based on animus and not evidence.

    The worst part of it though is that anti-drug measures are often as not motivated by compassion. People see the poor standard of living that addicts have and they say: “We have to stop this, if we ban drugs people won’t be able to get addicted to them!” People care enough to do something, but not enough to make sure they do the right thing.

    I don’t think this dynamic is even all that unusual in government policy (though drug policy is an egregious example). In my experience in government following the preconceptions of voters is much more common than following evidence. As to how to fix it? If I knew that I’d be out there doing it. But I think this is where scepticism can help – we need to spread empiricism as a moral value, believing things without good reason should be seen as a moral flaw. That way politicians who made unempriical claims would be punished at the polls, instead of being rewarded.

  10. Rasmus says

    There’s a 40-minute CBC documentary about it available for free.

    Caution if you’re icky about stuff: There is a lot of very explicit footage of injection drug use. Just so you know.

    Also, look out for shocking amounts of human misfortune and misery, if you come from any sort of moderately privileged background.

    One thing that strikes me as possible is that it might be tempting to demonize and/or dehumanize drug addicts simply because that makes seeing the level of misery they’re in more bearable.

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